The Coming Crisis in Patient Access to Physicians

The reason is Obamacare, of course, and the problem will be faced by almost every state in the union. For big states like California, the situation threatens to be so bad, people may be forced to go out of state for medical care.

Some lawmakers want to fill the gap by redefining who can provide healthcare.

They are working on proposals that would allow physician assistants to treat more patients and nurse practitioners to set up independent practices. Pharmacists and optometrists could act as primary care providers, diagnosing and managing some chronic illnesses, such as diabetes and high-blood pressure.

“We’re going to be mandating that every single person in this state have insurance,” said state Sen. Ed Hernandez (D-West Covina), chairman of the Senate Health Committee and leader of the effort to expand professional boundaries. “What good is it if they are going to have a health insurance card but no access to doctors?”

Hernandez’s proposed changes, which would dramatically shake up the medical establishment in California, have set off a turf war with physicians that could contribute to the success or failure of the federal Affordable Care Act in California.

Doctors say giving non-physicians more authority and autonomy could jeopardize patient safety. It could also drive up costs, because those workers, who have less medical education and training, tend to order more tests and prescribe more antibiotics, they said.

Such “scope-of-practice” fights are flaring across the country as states brace for an influx of patients into already strained healthcare systems. About 350 laws altering what health professionals may do have been enacted nationwide in the last two years, according to the National Conference of State Legislatures. Since Jan. 1, more than 50 additional proposals have been launched in 24 states.

117 Comments, 40 Threads

1.
John

Texas addressed its rural/inner city physician recruitment problem over the past decade with the medical liability lawsuit reform actions and by creating a fund that pays doctors up to $140,000 for agreeing to a four year contract to locate in low-served areas when they become certified to practice medicine in Texas.

With Obamacare looming, that’s more of what you’re going to see — states providing individual benefits as financial workarounds from the law for doctors in an effort to get them to relocate to their states. For states already in the deep red because of their deep Blue politicians’ past decisions, it’s going to be even harder to both find the money to make these new offers, and go against their trial lawyer special interests in lessening the financial risk for doctors.

I don’t think there will be a doctor shortage because we already are encouraged to see a PA or other similar person at the doctor’s office. Why would this “practice” change? Do you experience the same at your doctor’s office?

This has already happened in New Hampshire last year. I was forced onto obammacare because my wife’s company dropped spousal coverage due to obummercare costs and my cancer treatments were costing their policy too much.
I had to wait 3 weeks to see my primary care doctor because they could NOT refill a prior approved migraine medication WITHOUT the doctor “examining” me first and ZERO consideration was given to the fact that I was in constant agonizing pain and hiding out in a dark cold room with a bag of ice on my head. After 2 and a half weeks of constant blinding pain, I ended up in the E.R. for about 5 hours puking my guts out and generating a $6,000 bill.

Once I finally got my PCP appointment there were NO apologies, I NEVER got see the doctor, and his NURSE examined me, left the room for a half hour, then came back with with a prescription for the EXACT medication that they could NOT approve over the phone. When I asked why I had to come in to see the NURSE and NOT the doctor yet PAY like I had see him, I got the typical ” because this is how obammacare is forcing us to do things “answer.

Typical gubbermint waste:

suffer like a dog, pay like your a king, and get services like a slave, if you get ANY services at all.

Currently there are some laws (state and Medicare, I think) that will only allow patients to see a PA for followup. I have an 18 y.o. daughter who just needed a checkup and the scheduling desk said “She has to see the Dr. first”. Except her doctor is no longer here, and she wanted to see a female.

So I said “Ok, this is a followup check for whiplash.” (Which she had years ago).

They scheduled her for the next day.

I did tell her to be sure to mention the whiplash in passing so the PA could get paid.

Doctors already waste a lot of time and patient’s money because the government has created a monopolistic system where doctors are the only ones with legal access to medical drugs. If you have a chronic disease (high blood pressure and high cholesterol are two common ones), all doctors can do is medicate you. The medication treats the condition, but it does not “cure” it. Much the same thing is true with virtually all chronic conditions. The doctor could write you a lifetime prescription which would work just as good as anything else he or she could do. However the doctor wouldn’t make much money that way. His or her income would drop by a considerable amount. So when you go into a filled waiting room to wait your turn, consider this: Probably half of those people are there because the doctor wants them there to collect an office visit fee. They have also had lab tests (profitable for the lab doing them) which simply proved that the patient had the chronic disease which was already known. In effect, hundreds of billions of dollars are spent every year putting money into some medical provider’s pocket, because the medical providers have the power thanks to the government’s prescription laws that give doctors a monopoly over medical drugs.

There is no “shortage” of primary care doctors. However thanks to prescription laws that allow them to do “rent seeking”, they can make it appear that there is a “shortage”. Without prescription laws for non-narcotic medical drugs, there would be no “shortage” of doctors at all. Government and the AMA have created this “shortage”. Prescription laws increase the cost of health care by hundreds of billions of dollars a year. The health insurance industry also obtains higher profits because of these laws. The labs earn extra profit because doctors order unnecessary lab tests to go along with those extremely profitable twice a year office visits. “One hand washes the other” in the health care monopoly. Without these laws, the cost of health care would be far less. Enough less that most people could use “Health Savings Accounts” using pre-tax money instead of having to buy health insurance. As a matter of fact, we could probably develop a means of paying for health care through long term loans. Something like this actually did exist at one time where people paid for their own care sometimes over a period of years. It is “government” that is responsible for high health care costs along with the professional organizations that function much as labor unions do in increasing the income of members of the professions at the cost of everyone else. Something to think about here. Libertarians such as myself have been pointing out these facts for a long time. The free market works. Government enforced monopolies don’t!

Written like someone who has never managed the diseases, I personally am strongly in favor of allowing OTC status for all non controlled substances, the doctors offices would overflow with folks with side effects and complications

Welcome to the former Clinton Care, and now deemed Obama care Act! Our government has gone full blown Fascist! This must be Progressive! Want to know what is really going to happen, look no further than the Indian Reservations for insight. Our government has provided there care for decades!

Obamacare is worse than Clintoncare would have been. Obamacare will create the illusion of health insurance, but in a form that will be unusable for many people. For example, the lowest cost “Bronze” plan under Obamacare (the one most low income people will select) has an “out of pocket” deductible of about $4,000 dollars. Then it will pay 60% of the remaining bill, leaving the other 40% up to the individual. So with a $10,000 bill, you end up paying the first $4,000, the plan pays 60% of the remaining $6,000, or $3,600, while you have to come up with an additional $2,400 or a total of $6,400 dollars. This folks, is NOT insurance. There are plans that pay better under Obamacare, but your costs will be higher too. For all practical purposes, most people will be better off paying the fine. Which according to the way the law is written, can only be collected by the IRS from any money that might be due to you as a refund. Just set up your payroll deductions so you end up needing to pay in a bit, and the fine can’t be collected (unless they change the law). Then if everyone votes Republican in 2016, Obamacare can be repealed and something better put in its place.

Yep.
From my time in the Soviet Union I noticed appalling conditions: Syringes “sterilized” with iodine and “sharpened” with steel wool. Doctors with the training of US nurses had to grind such syringes into the skin.
No aspirin or any kind of pain relievers available.
The rooms were dark, bare and dirty. Patients lying in hallways.
Surgeries performed with no idea of the diagnoses.

It is somewhat better now thanks to Western techology and methods which were created by, you guessed it, the free enterprise system.

We’re stocking up on OTC pain items, topical antibiotics, hydrogen peroxide by the gallon, bandages etc. and getting to know professionals (on a personal basis) who will stitch us up at thekitchen table when it becomes necessary as obama’s iron curtain descends.

Probably worse care than what Soviet citizens got because theirs was “free at the point of service” and while not worth that much, was still better than nothing. However, under Obamacare, your out of pocket deductible is a “problem”. Especially for low income people. Had we simply repealed prescription laws for all non-narcotic medical drugs, it would have been a much better “solution” than Obamacare. Because once you eliminate these laws, people then have “access” without having to obtain “permission”. It’s not that difficult to learn what you need to know to take care of most of your health needs. And computer software exists to assist you. Treating things like high blood pressure and high cholesterol is easy, and shouldn’t cost you more than $10 a month (based upon Walmart pricing). Of course the medical profession doesn’t want you to know these things, because they make their livings exploiting the advantages of operating under a government enforced monopoly where only they have legal access to even the most common medical drugs. Those interested in following this train of thought further should read my blog at “muskegonlibertarian.wordpress.com”.

Some of the things you say make sense. Others are completely wacko (like your last comment).

There are drugs available that can help you. Go decide which one or combination to take, what dose, how often, what side effects to watch for, what to do about them, what other drugs it might interact with, and what to do next if the drug doesn’t work well for you.

Stay close to an ER while you’re experimenting, so someone competent can scrape you off the pavement and save you from yourself…

We are already seeing a promotion of PhD’s for Nurse Practitioners and PA’s. Soon we will see independent practice models for them, but the crunch will come when none of the real doctors will accept those patients in referral fearing involvement in liability created by the half trained. This will make your neighborhood nurse run clinic a dead end in more ways than one.

Allowing anyone with a medically related licensed to practice medicine will simply make the overall physician shortage more acute. Why Incur the direct and opportunity costs of 8-12 years of formal education when you can perform the same service with far less effort. Either medicine is extremely complex and requires a significant amount of training And experience to do well Or anyone with a health-related license can do it as long as they have access to the Internet. I’m reasonably certain that none of those advocating expanding Licensure laws would consider going to an optometrist for comprehensive diabetes care. The real physician shortage is going to emerge during the next five years as large numbers of physicians retire or segue into concierge practices as their work life becomes untenable and their sacrifices taken for granted by the low information children that now make up the electorate.

Atlas shrugged Is looking less like literature and more like prophecy with every passing day.

How much knowledge have you retained after say 12 to 16 years of education? The human brain does not do reliable data storage. You only retain what you use on a regular basis. Which is for most people a fraction of what they orginally learned.

We already see Canadians coming to the States for medical care because of the wait time, does that mean we will be seeing Californians coming to Texas now to see a doctor? Will the only doctors left in California be the Concierge type where they only treat the ultra rich?

Another worry on my mind, I have a service connected disability being treated through the VA. I’m wondering if that will last. Will Obozocare and all these cuts to the military budget cut into that? Right now we have a really good little VA clinic here in Daytona, I would hate to have to drive 100+ miles round trip to Orlando just to see a doctor in the VA Hospital over there.

Occasionally, once in a blue moon, Moran will write something worthy that keeps me coming back. Today is one of those days. But we have had a shortage of primary care physicians, especially in rural areas for at least a generation now. Obamacare will only exacerbate a huge problem that Americans are only now realizing has existed for quite some time.

Even without Obamacare, medicine was experiencing a shortage of available residency slots in hospitals, so the idea we will just allocate for more doctors is not as simple a task as it may seem to a politician.

I recently attended a minor emergency center affiliated with one of the top 50 hospitals in America and never saw physician. The only reason I went there was my own internal medicine physician couldn’t get me in for two days. My primary contact at the minor emergency was with a physician’s assistant. While she was friendly enough, there is no way she had the capability of correct diagnosis of an emergency doctor and it became most obvious when I deviated from the routine. I personally had to make the request for a chest x-ray, where I was diagnosed with pneumonia. While not a physician, I did have a go through part of medical school that would give me a heads up most patients wouldn’t be familiar. I doubt most patients would have thought to request a chest x-ray. Afterwards, I went to the pharmacy only to discover I had not received the correct medication. It was a mess. Glad the malady wasn’t life threatening.

Being I do have a daughter that will be a physician in a year, I am terribly worried about her own career path. She was bright enough she could have been anything she wished to be and it was her daddy that gently pushed her toward medicine over engineering, never dreaming Obamacare would actually become the law of the land.

In the current environment, we will never be able to attract enough qualified candidates to enter medicine that aren’t specialized. The daughter has a full tuition scholarship to med school and will still have approximately $125,000 in debt for living expenses, of which her parents will help pay, though she has requested we not. I can’t in good conscience not help. My daughter won’t get her first real paycheck until 32. And $150K a year in salary in salary won’t begin to defray the expenses and lost wages she will incur vis-a-vis some other fields she could have chosen. While that sounds like a huge salary to most Americans, it’s really not when consideration is given to the time invested, the training required, the monies defrayed, and the hours worked. Most Americans have no idea how many hours doctors work in a typical week.

I’m afraid Americans are in for a rude awakening in the next decade. Better hope you stay healthy, your own immune system uncompromised and have a physician somewhere in the family.

What an arrogant and ridiculous posting. If your daughter was “pushed” into medicine, I don’t ever want her near me as a physician, do you hear me? Ever! And she spent $125,000 on “housing”? Where was she living? Versailles? The Taj Mahal? Another example of a totally ficticious posting.

What makes you think she would want you as a patient? Or are you so rude and arrogant as to assume that any doctor would thrilled to have you in their exam room.

Full scholarships to medical school are very rare and she is picking one of the most challenging fields intellectually. In a room full of smart accomplished people I wager she is heads above the crowd. Go see someone else.

And she spent $125,000 on “housing”? Where was she living? Versailles? The Taj Mahal? Another example of a totally ficticious posting.

You think $30,000 a year, including living expenses, food expenses, additional medical equipment required, travel, etc…is living in Versailles? Without assistance from mom and dad, my daughter would be practically living hand to mouth. The life of a medical student typically is hardly luxurious. Trust me, boner.

Be glad it is my sweet daughter who is the doctor and not me. I would terminate your type with prejudice and untraceable, and the world would silently cheer me.

She is making a good choice with endocrinology. She will be in demand as a subspecialist. She will have a better lifestyle than a lot of fields with regular hours and little call or middle of the night emergencies to worry about. Her best bet would be take a job in a big group so she can get regular hours, vacation and benefits. The debt, well maybe moonlight a little for the first few years to get a jump on the principle then just pay off the rest over time.

The trend everywhere now is docs are finding it is just not worth it to take on the heroic hours, call, and large case load. So they are not taking on new patients or extra call hours. Most I know are scaling back retirement goals to get out earlier and enjoy life a little more.

Your contention that overall care quality is certainly unusual (that is if you are not simply a troll), and not borne out by other top down systems serving populations much smaller and less heterogeneous…….We shall see.

The US “system” of healthcare is absurd and Obamacare does little to address the absurdity. Instead of fanciful “let’s subject health care to the free market” which is an utterly unproven solution best left to naive young Randian acolytes, how about we try to learn from countries who have recognized health care a a basic human right and provide health care through some modified single-payer system ala Singapore, Switzerland, the Netherlands or Germany. Yes, protocols (rationing) are used in all those systems, but everyone has coverage and outcomes are far better than we have in the US>

Brutus, all those countries with single payors you listed also have no medical torts. Malpractice claims are either adjudicated against the government or within a mediation system. Imagine a single payer system which also has to include the cost of our current malpractice system, for the trial lawyers will never allow it to be otherwise. Currently a physician is the rare altruistic individual who has the combination of intelligence and character to delay gratification for a decade while assimilating terribly difficult information. For doing so, there were significant financial and social rewards. Under a single payer system, not only will they be publicly chided for wasting their time in education (” 80% of what they do is by rote”) but now there will be limited financial rewards and wide open soul searching liability. Better to become an engineer, earn the same 150k ten years out and forgo both the public distain and the liability.

Healthcare, more than any other endeavor, depends on the goodwill of those who perform it. Without those good intentions, you get a Toronto ER or Shropshire hospital, no matter how many regulation you write. I hope you never get to experience either, but I am afraid you will

Thanks anon, you are absolutely correct that countries with single-payer (and other financing mechanisms that are not strictly single-payer) do not have the same tort system that the US has. But eliminating malpractice alone would do little to create a health care system as good as those in other OECD countries (in terms of coverage and outcomes). Some one here has stated that malpractice adds 2% to the cost of coverage. Health care is mostly not for profit in EU countries, no doubt saving somewhere between 10-15%. I live in one of those nanny states, where health care is seen as a right, not a privilege for those who can afford it. The terrible outcomes? Everyone has excellent quality health care, no pre-ex, no one goes bankrupt from medical bills, and per capita spending and spending as a percentage of GDP are lower. It isn’t a perfect system, but far better than we had in the US. I think the US can learn some things from other systems. But we won’t.

No one knows how much malpractice adds to the cost of care- by some estimates it could cover every uninsured person in the US. It’s not the cost of the insurance that drives up the cost (that 2% you quote), it’s the defensive medicine.

For example, in obstetrics the cost of defensive medicine is probably half to one third of the cost of prenatal care and delivery. Numerous studies have been done showing that women get far too many prenatal visits especially early in the pregnancy. Yet no one dare cut back on those visits. Most women can safely deliver a baby normally after a cesarean, but good luck trying to find a doctor who will do it.

Defensive medicine is everywhere, and it’s so pervasive, so baked-in to the medical field in the US I don’t even think it’s possible to get an accurate handle on how much it costs. But it’s huge.

The problem ain’t the cost, it is the soul searing multi year pain experienced by any physician who has ever been sued. Who in their right mind would expose themselves to such a risk if other options are available

I don’t think the patients in the shropshire hospital or the VA in buffalo (google them) would agree with your assessment if care quality either

“I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything — except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind — yet what is it that they expect to depend on, when they lie on an operating table under my hands?” “I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind—yet what is it they expect to depend on when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of the victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of man who resents it—and still less safe, if he is the sort who doesn’t”.

In Oncology, as in other fields, we have seen a gradual deterioration in independence and reimbursement, but most of us have managed to absorb these hits and provide the care for our patients that we would want for ourselves.

But enough is about to be enough. You will see that as Obamacare becomes the standard of care, we will no longer be able to protect our patients from their misguided whims about healthcare policy.

Cut and paste directly from “Atlas Shrugged” earns you 12 demerit points. Under the Randian dogma, you must be able to paraphrase for at least nine pages (single spaced, 12 pt font) or you don’t get to be in her club. Sorry, come up with you own rationale, or at least your own words. Rand wrote fiction.

Understand something, Brutus. Even in those countries, health care is not a right. A right is something you have on your own, intrinsic to yourself. It imposes no obligations on others for you to have it. By defintion, health care does not fit. At best, health care will only ever be a social privilege afforded by a society to its citizens because health care is a service that must be provided by one individual to another. If you try to make it a right and think of it as such, you devolve the individuals who provide it into the role of slaves to your needs.

Doctors are not slaves. At most, they can be public servants. But when you make their service your right, you reduce them to your personal slaves to be used at your whim.

Sorry guys and gals, but your Ayn Randian psuedo-libertarian claptrap, rather than any actual experience or knowledge of the healthcare delivery systems of of other countries renders your views moot. “Obligations on others, coercion, liberty, I’m the only rational person in the room, etc.” is good for what? Nothing. What are our solutions? Nothing. How about trying what has been proven to work elsewhere? I have lived under both systems (have you?) and there are things we can learn from other systems. That we continue to allow our fellow citizens to suffer needlessly and die from lack of adequate health care shouldn’t be acceptable to any of us. Unless you are a so-called libertarian for whom “principle” trumps reality.

“how about we try to learn from countries who have recognized health care a a basic human right ”

Remind me again: wasn’t there some small dust up, perhaps a war, that declared that we, the U.S. was not like other nations?

Health care is NOT a “basic” human right. Unless you think that you have a “basic” human right to the services of others. Water, necessary for life, should then, under the “human right” excuse, be free to me at any time I decide I need it, if I don’t have the means to pay for it, or frankly make decisions that don’t allow me to pay for it, yet I think my city would not be so kind as to leave my water running if I failed to pay the bill I receive for it.

Okay, Brutus. Take the rest of the day off and devote it to thinking about this. Healthcare is provided by human beings. If you have a “right” to their services as mandated by government then the providers are obliged to provide their services to you simply upon your demand. People who are obligated to you regardless of their willingness to meet that obligation on your terms are known as “slaves”. On the other hand, people who provide their services willingly to you upon mutually agreed terms are known as participants in the “free market”. The next moronic statement that I suppose you will make is to state that you have a “right” to housing and that I have an obligation to provide a home for you whether I wish to or not. Brutus. I have but one thing to leave with you and the next jackass that says “healthcare is a right” (to be provided at someone else’s expense) and that is this. Please try to think the full implication of what you say before you simply belch out such an inane bumper sticker remark. Otherwise, screw you.

Oh, yea, Germany, the flaship of healthcare!! I visited one of these fine establishments a few years ago. Yes, they were very friendly and professioanl, but there was some nagging problems. Let’s see, no pain medicine for closed, non-compound fractured bones, casts for minor sprains and, oh wait, here’s the kicker — no pain medication or anesthesia for birthing mothers (my wife) — as it “is a natural proces.”

Also, no treatment goals that were agreed upon with physician/patient, and very few second opinions, as it was “my way or the highway” treatment options. To pay for this lovely system, 17% VAT, and about a 50% income tax. Yea, a very lovely “free” system they have.

I would LOVE to hear how your opinion changes when you or a close loved one gets cancer or some other life threatining illness and is told that you get to wait in line while a faceless panel of beuracrats decides if you are “worthy” of treatment, NOT if the medicine available.

It seems you have endured a personal experience from which you are drawing generalized conclusions that are simply wrong. At best, your ideas make you appear naive, but your vehemence about your beliefs indicates a deeper animosity toward American healthcare, which heretofore has been the best healthcare system anywhere.

There are always exceptions – there always have been, because individual people have been involved in the delivery and receipt of that care.

But it has been the best system in the world because until now, individual people have been involved in the delivery and receipt of the care.

When it’s up to the government, you get government quality.

The DMV may be nicely landscaped, and if all you need is a routine license, probably an ok experience. But God forbid you actually need individual attention for an unusual problem. Then? Well then. Welcome to Obamacare.

Does the individual serve the state or does the state serve the individual? Which is it? In what world do you wish to live? Which world will provide the best standard of living for its people? Will you be a servant or a master?

Also, I have lived, trained AND practiced in England with the NHS, trained in DRK Kliniken Berlin, Toronto General, Tokyo Medical University as well as visits to facilities in Singapore and Athens. There is no place I would rather be sick, with insurance or not than the USA. I hope I can say the same five years from now.

“What good is it if they are going to have a health insurance card but no access to doctors?”

It would have been nice if the liberals in Congress answered that question BEFORE they passed Obamacare. Now we’re stuck with it. And it doesn’t seem that Congress is going to repeal Obamacare any time soon, so it WILL remain the law of the land, even if there are no doctors to sustain it.

And you STILL do not hear anything about tort reform when it comes to medical malpractice law suits. This is a major reason why doctors are leaving the profession, simply because they cannot afford the malpractice insurance premiums anymore. If Obama wants to keep a lot of doctors from leaving medicine, he has to address this issue. Obama doesn’t want to admit it, but most doctors are also small business people, either running a practice or being part of a practice. If the can’t afford to STAY in practice, then they will leave. But since the trial lawyers are in bed with the Democrats, don’t expect to see any action on this in the near (or even distant) future.

You know, Liberty. You’re right but what I learned about medicine the worst part about the threat is not the current monetary liability incurred but the way it changes the practice of medicine because of potential liability. That and the positively ignorant, stringent rules established by HIPPA – that part of the cost and disruption not so easily measured.

For instance, my story above about the diagnosis of pneumonia? My youngest daughter had the previous week been in the same minor emergency for the same basic symptoms and was diagnosed with bronchitis. My daughter is on my insurance as a college student. When I asked for them to review her diagnosis against mine or let me take a look at the procedures and results, the staff informed me they couldn’t do that because I had no privilege to do so. Oh, they thought is was asinine too but they could have lost their license if they would have let me review my daughter’s records without my daughter’s written consent even when I was the primary.

Worse, it is not that most doctors are ordering unnecessary tests to pad the bill. Doctors are either instructed to by the administration because of legal threat or their own personal threat of liability to cover every contingency when that is generally unnecessary. Where a simple X-ray used to suffice, now the chances good that a CAT scan will be ordered – a much more expensive process.

That’s a large reason why the practice of medicine has gotten so expensive. And that’s something you never here mentioned in lawyer’s claims of only adding about 2% to the cost of aggregate medical treatment. Baloney.

Roger that. And there are cases where the proliferation of non-meritorious lawsuits have driven perfectly safe and highly useful drugs off the market. The drug makers simple can’t afford to defend countless lawsuits and still make a profit on the drug.

The notion that doctors order excessive tests to pad the bill is mostly fictitious and slanderous to boot. Most physicians have so much work to do they surely don’t look around for more things to do to treat a given patient. Don’t think so? Try calling a prominent physician in your area and see how long it takes to see him or her. It’s 90 days to see my wife unless you have an emergency. For my ophthalmologist, 120 days.

Now there are a few areas in the vanity practices such as the plastic surgeons who do breast enhancements, etc — procedures that are not covered by insurance and where the docs charge what the traffic will bear –that a little up-sell may be going on, but it’s the exception and not the rule.

You’re right about the cost of defensive medicine, Tex, but the worst part is the invasive tests- they actually carry some serious risk but doctors get sued for NOT doing things far more than they get sued for inaction.

FOr example, last year I was evaluated with a CT scan for an enlarged lymph node. The CT incidentally found that my thyroid was cystic- really not uncommon at my age. But, of course, that had to be biopsied to rule out cancer. I knew all that, and when my (non MD) friends expressed concern I told them not to worry about it, it was nothing. And so it was.

But that procedure (and others like it) is done thousands of times a day. People have allergic reactions from the prep or dye, or adverse reactions to anesthesia. Some may die. It’s a terrible situation, but the attending physician can not take the risk of a missed diagnosis. And if something goes wrong with the testing, it’s the “fault” of the radiologist, surgeon or anesthesiologist.

I don’t know what the answer is, but I can say that “My best professional judgment,” carries absolutely no weight next to the latest, greatest test that is just one order form away. And the plaintiff’s attorney will wast no time pointing that out.

Obamacare is a rampant disaster, and what I expect is that after much misery, large parts of it will be repealed over the next ten years, whoever is in power.

However as far as increasing the use of nurse practitioners and the like, that has been discussed for decades, and most academics not members of the AMA, have been all for it for thirty, forty years, maybe longer. The argument is that 80% of what goes on in a primary care physician’s office is completely rote, and much of it largely unnecessary, checking status, treating colds, etc. Frankly I’m not much impressed by most of the doctors I’ve ever seen, they might be good for such rote stuff but not much more.

The danger is that you get doctors or nurses or whatever who aren’t even that, but just working from some bureaucratic cheat sheet, and they won’t listen or really practice medicine at all. The bureaucrats will call it “best practice”.

The same people that caused this mess can fix it simply by subsidizing medical education. If the gub-mint pays for your med school, you sign on to work for the gub-mint for so many years in a specified locale, at a specified salary, until your debt is paid. And don’t forget the new affirmative action quotas that will be in place to bring those numbers up. What could go wrong?

Ok, Obamacare sucks. What, please tell, is the solution to the ridiculous system of health care we have in America? “Free market” is unproven. What do YOU propose we do with US health care? Sell across state lines, eliminate malpractice (a very dubious proposition) may offer some marginal improvements but do nothing to address accessibility and affordability. Romney lost at least in part because he could nt articulate a better solution. What do you propose?

Ah, Brutus:
” ‘Free Market’ isn unproven.”- far as I know we had a basically free market until the “Great Society”, an it worked.
-malpractice reform, would make a big difference. Someone above suggested the malpractice costs were 2% of medical costs. I doubt it’s that low, but 2% of a medical industry that is over 15% of GDP- say $17T- would be about $50 B a year, a nice start.
- allowing insurance competition across state lines would provide savings in specifically the states, i.e. California, where there is the least competition, savings ? multiple millions at least.

Or, we can continue down the obamacare rat hole until we die, as a nation and individually, one at a time.

Remove insurance from routine care coverage. Expand HSAs to fill that gap. Insurance should be policies to cover single individuals started preferably at birth, portable for one’s entire life and used for catastrophic coverage with options to pick up chronic care riders that would cover any care related to chronic conditions. Most routine costs would then be covered out of pocket or HSA. With most of the larger players out of the market, costs should start to come down into the range of the average person again like they were prior to the explosion of comprehension insurance and government involvement.

Also, tort reform limiting imposed payouts and instituting a loser pays system with no out of court settlements.

Fewer doctors means longer waits. Longer waits mean more advanced diseases. More advanced diseases mean a higher mortality rate for patient. More dead patients mean less money spent in the long run thus saving the government money. That is the ultimate goal.

I’ll also so that I don’t think expanding Medicaid is the answer. All Medicaid has done is kill rural and small town health care by paying doctors and small hospitals so little they couldn’t afford to stay in practice. It has also wiped out many urban emergency rooms and make individual practices very rare. Severe tort reform, allowing competition in the insurance industry by allowing sales across state lines and the like would be much better.

Most of all it would help to rebuild the economy by bringing back good paying manufacturing jobs and putting people into work and off government programs. Of course if that can’t be done, take a page from the Democrats and tinker with demographics. That could be done by paying full welfare benefits in Democrat heavy cities and states and less in others. Over time recipients would crowd in around the liberals who support said programs thus easy the burden on those who don’t want them.

Try telling leftists that, and they’ll tell you that at least it’s something and something is better than nothing. I don’t think they really understand that just ebcause they’ll have Medicaid means they’ll actually get any care.

Today, we are constantly being told, the United States faces a health care crisis. Medical costs are too high, and health insurance is out of reach of the poor. The cause of this crisis is never made very clear, but the cure is obvious to nearly everybody: government must step in to solve the problem.

The AMA once had considerable influence but no more. Only about 15% of doctors are AMA members. I notice that some posters here feel that the AMA determines how many slots for medical school or specialties but that is not at all the case.

One of the many problems with “ObamaCare” is that it provides no incentives for people to become doctors and nurses. Where are these people supposed to come from?
Find out what has happened to the practice of medicine in Massachusetts with RomneyCare, the model for ObamaCare.

Good luck to your daughter, Tex. She will be beginning her career at one of the most precarious time those in medicine have ever faced. After medical school and its attendant expense she will endure three of four years (or even more, depending on the sub-specialty) of residency where her salary will be very modest, barely enough to live on. By that time Obamacare will change medicine in this country forever. Those coming later can decide if they want to make the investment of time and money for whatever rewards there may remain. But those caught in the squeeze may simply have their intellectual capital confiscated by the government and have no real choice but too stay in the system regardless of their earnings.

A word to the wise parent: Where she does her residency will very likely be where she works, so if you want her close to home, or away from California, etc, applications for residency should be made accordingly.

Thank you, Songdog. Six years for her residency (Endocrinology) unless she changes her mind between now and then. And though raised in Oklahoma, she’s now pure Texas with her Texas boy love a fourth year med student at the same med school.

Basically doctors become slaves of the federal government. They work where they’re told. Get paid what the government says. Work the hours they’re told. Live where they’re told. Only conduct the treatment the government says is ok regardless of the needs of the patient. They must treat only those the government permits and must deny treatment to all the rest. They must limit treatment to those whom unelected government bureaucrats say still have something to contribute to the state, and must hasten the death of those the state says will be a burden to the state. I’m sure this will soon be followed with not optional abortions and optional euthanasia but forced mandatory abortions and forced mandatory euthanasia as dictated by the state based upon a government established standard that assesses the continuing and future value to the state of an individual. Of course the Hippocratic Oath will be eliminated.

If you’re wondering what medicine will be like in the future world envisaged by our wonderful President, our national daddy as Chris Rock likes to tell us, look no further than Aleksandr solzhenitsyn’s book, Cancer Ward.

And let’s not forget that you still do have a choice. Remember, if you become a federal politician or as Aleksandr would say, a Party Official, or a muslim, you are exempt from Obamacare and can seek medicare care at one of the special Fidel Castro medical centers nearest you.

I’d turn on the sarc tag but I’m afraid what I’ve described is all true or will be in our lifetime.

But the problem didn’t exist before Obamacare only because uninsured people essentially had no access to physicians at all. In other words, the problem is caused because people who couldn’t see doctors now will be able to.

So why wasn’t that a crisis? Oh right, they’re poor so they don’t count.

The real problem will have to be solved now – that of doctors essentially forming a protected guild. No, not every illness does need a doctor. A lot of things can be diagnosed by other people like nurses and pharmacists. Part of the reason medical costs have been so high is that doctors have artificially reduced access to health care as a policy of protectionism so as to boost their own salaries.

You cannot have it both ways, either medicine is complex and requires a great deal of effort and investment to master or it is mostly knowledge application requiring a basic science education.

Either it is important to recognize and cultivate expertise as is evidenced by the ever growing number of specific certifications ( NCQA, AHQA etc….) or anyone with a medically related licencse can do it.

Either there is a very high level of skill expected from the doctor by the patient which can be cited in court if the patient believes the standard of care has been breached or there is no special tort relationship between the two.

How sustainable is a system that pays providers the same regardless of education level but holds those with the highest training to the highest level of liability? Would any reasonable actor try to attain mastery?

The clay that can be formed into a physician is a rare thing indeed. The individual must be highly intelligent, altruistic and able to defer gratification to a nearly phenomenal degree. There are many fulfilling and less costly alternatives for such an individual in our society An engineer can be in mid career with money in the bank before a physician earns dollar one. Why should such an individual become a physician if they are disdained, under-compensated and threatened with litigation their entire career? If you know of some magic that can summon more such individuals, please share. From what I see of the current generation, it aint there. The “guild” of which you ignorantly speak is a function of the rarity of individuals who choose to take on the challenge of medicine, not of some AMA conspiracy…….you will soon note their absence.

As for the “poor”, I shall assume you are referring to the truly needy, not those who forgo medical insurance in favor of cell phones and cable and big screen TVs. The true poor have always had access to health care, through the ER and through Charity based health systems.

Read the soliloquy of Dr Hedricks in Atlas Shrugged and you will see the future

Having worked with the “poor” I have not met even one of about 1,000 who couldn’t get in to see a doctor. It was more of bad choices taken by these people. The biggest reasons that they couldn’t see a doctor at the local county/inner-city/charity clinic/Catholic hospital is because they’d rather pay $25.00 for a carton of smokes or $100 for booze and crack instead of the small visiting fee, which can be waived in most cases.

I’ve worked in clinics that had to have armed guards to keep the gang-bangers/drug addicts at bay, so from what I have experienced and studied, poverty has very little to do with access. Yes, there are quite a few who cannot afford their insurance, or cannot afford their medications, but these are red herrings as there are programs in place for those people. Access is there for the vast majority of “poor” people who are willing to get it.

That’s right. The media confuses being uninsured with not getting care, but that’s not true. My own hospital actually goes out of its way to get people into the “charity” (vs. the “bad debt”) category as soon as people hit their door. It’s a waste of time to get blood out of a turnip, and (believe it or not) it’s actually their mission to help the poor.

And as for the statistic that most bankruptcies are due to medical problems, that’s spin, too. It’s due to folks losing their jobs after falling ill, not the bills. Both the hospitals in my small city would never take someone to collection over something like that. It may be unfashionable in other parts of the country, but they do worry about their image. It would be terribly bad for business.

@ Jeremy
You’re right about the AMA, et al, holding down the numbers of doctors. When the military started it’s own medical school program- you get the education for 5yrs in uniform, same as the service academies- the medical profession fought it tooth and nail.
While it takes real talent to complete medical school, there are still fewer slots than qualified applicants. Maybe some of these doctors who will quit their practices, with good reason, because of Obamacare, could be imposed upon to teach their replacments at public medical schools built on the same idea?

My husband and I had no medical insurance for about 10 years, had extensive health issues, NEVER had a problem seeing a doctor….and we paid our bills ourselves, which took several years….but at the time they saw us and provided the care, they had no way of knowing whether or when or how he bills would be paid. What you are claiming is simply not true.

Folks, have you noticed how the liars complicate problem-solving? And it’s far, far worse when they also occupy some of the highest offices in the land. What a mess.

ObamaCare aside I think its high time we rethink our health care system – or more precisely how we use the Dr.s in the system. We have a systemic problem – too many of us rush off to a Dr. at the first sign of a fever or rash or some ailment or another that more often than not isn’t even life threatening. Symptoms that could be handled by a PA or a ‘super nurse’. Or better yet – at home! Most of those PA’s already know the signs of things they cannot treat – and send that patient off to see a Dr. or specialist.

Oftentimes patients with chronic diseases like diabetes heart disease or arthritis who’s symptoms may be no better but are no worse have to visit the Dr. every 3-4 months for more prescriptions. Many of them are on medicare/medicaid or VA medical. Why not hand off some of that load to a pharmacist or PA – or a nurse? Why not use video chat to talk to one of them? Why the need for a blood test and visit with the Dr. to follow before ‘granting’ the next prescription? Is there enough prevalence of diabetes in most areas of this country that a specialist type clinic staffed with knowledgeable people can care for those patients? Have a Dr. on hand to oversee the operation.

We need to rethink when and how we visit the Dr. Why not let a pharmacist dispense Tamiflu? By the time you get an appointment with your Dr. it might be two days later – the faster you get and start taking Tamiflu the faster you begin to recover. And you expose many less people to the flu.

There are so many ways to rethink when and how we use a Dr. Instead we are all pissing and moaning about how the Dr. shortage will affect everything. Lets get prepared – its going to happen anyway. May as well get ready for the blow.

And the first thing that needs to be done is wide sweeping tort reform. Without it none of these ideas will ever gain traction.

An Ass masquerading as a President once found a Doctor’s white lab coat which had been left out in the sun to dry. He put it on and spoke to his countrymen. All bowed, both men and women, and he was a proud Ass that day. In his delight he lifted up his voice and brayed treatments and prescriptions randomly and incoherently and then everyone knew him for what he really was.

They’ve actually figured out that having health insurance coverages doesn’t necessarily equate to having access to healthcare.

Next thing you know, they’re gonna figure out that the math doesn’t work and that obama lied and a whole bunch of people applauded and cried out, “Yea! Yea! He’s our man! If he can’t do it, nobody can!”

They’re so cute when they get the ah-ha moments. It’s really too bad it’s about three years too late, and about 38 months after the majority of normal Americans already knew these things. But no–they wouldn’t listen to us peons who balance our checkbooks and pay our bills as we go.

I find it interesting that people who call themselves conservatives see no possible benefit i having other professionals compete with doctors.

CVS, Walgreen and Rite Aide are all working on establishing clinics to provide immunization shots, take blood, treat headaches, runny noses and the like. The prices are very reasonable, and these groups do not pretend to, nor to they want to, be involved in the heavy lifting work doctors do. And they are the first to recommend seeing a doctor if the patients requests fall outside of their work.

If I go to my doctor for a flu shot I pay a twenty dollar copay and I get a copy of the doctor’s bill to my insurance plan. He charges $187.00 and they pay be $87.00

At Rite Aid or CVS or Walgreen if I go there for my flu shot they charge me between #29.00 and $39.00 depending on which one I go to. The nightmares discussed by some posters about appalling conditions in Russia is a mistake. America isn’t Russia.

If medicine were no more complicated than a flu shot we wouldn’t need doctors at all.

We have evolved a minimal standard of training and certification to practice medicine over many years. The field is so complex that it requires specialists and subspecialists for many medical problems. What we are asking is can we take a step back from those rigorous requirements?

In any case no insurance company is going to pay $180 for the diagnosis code of “flu shot”. The charge is for a specific medical problem or for a physical if they cover those. The flu shot gets tagged on.

You seemed to miss the point about the question of “Where do Doctors come from?” and _additional requirements to see a doctor_ now that you can’t get a prescription refill over the phone for your chronic condition from the doctor that you’ve had for 15 years.

- The law mandates _more_ doctor visits for routine healthcare.
- The law has dramatically increased the number of people who can seek that healthcare.
- The law has increased penalties for doctors and limited their freedom and creativity.

Therefore more required visits plus more people requesting visits plus restrictions on doctors and most likely increased M.D. retirements coupled with decreased numbers of medical students = more effort and more cost for fewer successfully treated cases.

What has been happening in CA is a picture of what is coming nationwide with the new healthcare. There has been dr. shortages for some time now, and almost none will take the state welfare Medi-Cal, which unfortunately has Medicaid rolled into it so there is NO Medicaid here. Only the failed Medi-Cal. They have been allowing the usage of nurse practitioners more and more the last few years, to the point of extremely frightening and dangerous now. Most doctors I have talked to HATE the new bill, and wish they would never have gotten into medicine. While some years ago many just moved to other states, with the nationwide healthcare coming, MANY are just getting out of medicine period. A few quick examples of medicine here lately, just off top of my head, with my aged mother and her siblings:

One doctor office/group in town has SIX nurse practitioners seeing/diagnosing/treating patients, all under the ONE doctor.

Her cardiologist has a nurse practitioner seeing/diagnosing/treating patients in his office. Not only do they NOT have the education of a dr., they do not have the experience, or internship of a dr. And they absolutely do not have the invaluable education and NECESSARY experience of a SPECIALIZED DR! I cannot emphasize this enough!!! Yet they are seeing/diagnosing/treating, not only patients of a run of the mill MD, but also ACTING as SPECIALISTS and seeing/treating/diagnosing patients in SPECIALIZED MEDICINE!

My mom was in/out of ER, by ambulance. ER dr. instructions said see regular dr. AND cardio both, within ONE WEEK. Neither dr. would see her for AT LEAST THREE WEEKS, due to shortages.

Back to ER, about to just release her again, I ended up DEMANDING a cardiologist in hospital, which by law they must abide. Tests, bad, sent to nearest larger hospital, more tests and two stints. Said see normal cardio dr. within two weeks. Could not get in for THREE.

Took to cardio app., and in walks NURSE PRACTITIONER! I made app for cardiologist, after the recent major heart problems, and she only gets to see a nurse practitioner!?! Who, by the way, only told her how to EAT PROPERLY! Then said, “Oh, your Mom’s blood pressure is such a problem. Come back in two months.” END of appointment!

I changed her dr’s. (Both of them!) One artery surgery and two more stints!!

Some of the doctors working at the local hospital are also part owners of a home nursing company. They now release ALL patients after their stay with a home nurse, whether they need it or not! Talk about conflict of interest! Not to mention many are going home WAY too soon.

She had what we were told was cancer. From one dr. to the next, ended up having a gynecological oncologist surgeon, and surgery. Did surgery and NEVER SAW HIM AGAIN in hosptial! From there he sends in his NURSE PRACTITIONER for her care! We had NO IDEA he did this! Not only does this person lack the education and experience as a dr., but also as a gynecologist, as a surgeon, AND as a cancer specialist!!!

AND, Mom had post surgical problem, and nurse practitioner REFUSED to allow her to see dr! Said SHE is in touch with him, WE don’t need him! Then refused to talk to ME anymore, and would only ALLOW my mom to speak to her!

After home, on to follow up app. with surgeon. I tried discussing this, and he just didn’t want to hear it! (Thank goodness it ended up not being cancer and my Mom is okay! And we never have to see him again!)

Then there is the, tick the box, way that dr’s treat patients here now too. Basically it’s a symptom checker, and it is probably the reason my mom kept getting sent home from hospital time and again, misdiagnosed. It’s probably also why her care had gotten so substandard, resulting in her cardio health deterioration.

They use the same, tick the box, with medicines they use for whatever ails you. When released from hospital there is a list of medicines with boxes next to them, and they tell you the list is not the medicines they used, but the medicines they would have been ALLOWED to use! Only the ones with a tick were actually used. Each list based on what kind of ailment you have, cardio, gastro, etc.

This tick the box symptom checker medicine, is most likely also how two others I know were misdiagnosed, both with major heart problems. One, treated for stress, thankfully finally got a FIVE WAY BYPASS, before she died! Another to ER by ambulance, treated for pneumonia for three days, before they realized it was her heart! Thankfully again, new heart valve before dying!

Another had outpatient surgery. Was sent walking out door to car while blood pressure was extremely low. Passed out in hall. A nurse would know better, (any working brain would know better), but these are all nurses AIDS. There are a given amount of aids for every ONE nurse, per given amount of patients. And the education they are getting in these, “get certified quick” schools, are severely lacking! We had several phlebotomy specialists, whose only job is to poke needles, unable to get a vein, only to have the nurse or dr. hit it first try!

Another in hospital, and patient sharing room had epilepsy brain surgery. Middle of night had major seizure. Dr. came in and asked nurse if any seizures, and TWO nurses or aids said NO, NONE. My family member told Dr. NOT TRUE! He finally got them to admit. They didn’t even note it in chart. Why? They get bonuses for NOT CALLING DR., because their patients APPEAR better cared for if dr.’s not called! My mom had this happen too, as nurse wouldn’t call dr. when too much pain. Finally did when I threw a fit.

That brings me to another part of the new healthcare. Hospitals and dr.s will be rewarded with bonuses and/or payment(s) withheld, based on how healthy their patients APPEAR ON PAPER! This will only lead to them NOT doing tests and finding problems, NOT treating problems they know exist, NOT telling patients there is or could be a problem with their health. It is DESIGNED to NOT treat patients, and WILL lead to exactly that! Just like with the nurses! Especially since they cut their pay from Medicare every year already!

These true stories are the tip of the ice-burg, off the top of my head, experiences here lately. It is a nightmare, and due to get much worse. And it is going nationwide.

Three years ago I was suffering from terrible pain around my shoulders and chest and went to the ER. I was seen by a PA and told after tests and four hours that he didn’t know what was wrong with me but recommended that I see a cardiac specialist. I left on a vacation a week later. The pain came back worse than ever and I went to dumpy hospital in Hawaii and was seen by a physician. He diagnosed correctly almost immediately — it was not my heart but a rheumatoid arthritis condition. I’ll never trust a PA again.